Closing the quality chasm in mental health and substance use care
A plan to ensure that evidence-based psychosocial interventions are routinely used in clinical practice and made a part of clinical training for mental health professionals was released today by the National Academy of Medicine (NAM).
The NAM report, titled, "Psychosocial Interventions for Mental and Substance Use Disorders," points to a strong need to strengthen evidence on the effectiveness of psychosocial interventions, and to develop guidelines and quality measures for implementing these interventions in professional practice. Though medications undergo a systematic review of their efficacy, no similar process has existed for psychosocial treatments. The report sets forth a detailed program that identifies the steps needed to close this problematic quality gap.
Mental health and substance use disorders affect approximately 20% of the U.S. population, and frequently occur together. The rate of comorbidity of these disorders with physical disorders is also high. Psychosocial interventions for mental and substance use disorders include psychotherapies, community-based treatments, vocational rehabilitation, peer support services, and integrated care interventions. These are delivered in individual, group and even virtual settings, and may be administered as stand-alone treatments or combined with other interventions such as medications.
The NAM report proposes an iterative process that engages consumers at every step of a cyclical framework to 1) strengthen the evidence base for interventions; 2) identify elements of effective intervention; 3) conduct independent systematic reviews to inform clinical guidelines; 4) develop quality measures; 5) and implement interventions and improve outcomes.
Addressing the quality standards for psychosocial treatment is particularly critical given the recent passage of two significant pieces of legislation: the Mental Health Parity and Addiction Act, and the Affordable Care Act (ACA). The ACA expands access to health insurance and aims to reform how care is delivered, with an emphasis on accountability and performance measurement. The Parity Act redresses limits on access to behavioral health care services. Defining standards for psychosocial interventions and implementing strategies to monitor the quality of those interventions will assist in making these two acts effective.
"Psychosocial interventions are a huge component of how mental and substance use disorders are treated," said Harold Pincus, M.D., professor and vice chair in the department of psychiatry at Columbia and an author of the report, "Yet they have been largely left out of health care reform. This report describes how to incorporate these interventions into the mainstream, outlining how treatment decisions can be made at both a clinical and policy level, to increase the likelihood that people will receive evidence-based care."
Myrna Weissman, Ph.D., the Diane Goldman Kemper Family professor of epidemiology and psychiatry at Columbia University Medical Center said, "The NAM report acknowledges the value of psychological interventions and the evidence supporting their efficacy. Treatments so important to health need to be rigorously defined, taught, practiced, and made accessible." Dr. Weissman is also one of the authors of the report.
The title of the National Academy of Medicine Report is, "Psychosocial Interventions for Mental and Substance Use Disorders." The report is authored by the NAM Committee on Developing Evidence-based Standards for Psychosocial Interventions for Mental Disorders and the Board on Health Sciences Policy; Mary Jane England, Adrienne Stith Butler, and Monica L.Gonzalez, Editors. Dr. Harold Pincus and Dr. Myrna Weissman at Columbia University Medical Center are members of the committee.